主动脉夹层合并冠心病联合介入26例疗效评价

目的评价冠心病合并Stanford B型主动脉夹层的患者行冠脉介入治疗(PCI)和覆膜支架联合介入治疗的疗效和安全性。方法收集2002年4月至2010年10月沈阳军区总医院完成的26例覆膜支架联合PCI治疗Stan-ford B型主动脉夹层合并冠心病患者,首先完成主动脉夹层覆膜支架置入术,3～7 d后完成PCI。观察近期及远期疗效。结果经桡动脉行主动脉造影:其中1例2个破口,夹层破口位于左锁骨下动脉外缘分别为15 mm和100 mm;其余25例均为单破口,夹层破口位于左锁骨下动脉外缘10 mm以下8例、10～30 mm 11例,>30～100 mm 6例。置入26枚支架,8例覆膜支架近心端部分或完全封闭左锁骨下动脉,术后左上肢桡动脉波动稍有减弱,但无上肢和脑缺血的症状。覆膜支架置入成功率100%。术后即刻造影:16例近端破口完全封堵,13例少量残余内漏。冠状动脉造影证实单支病变16例,2支病变8例,3支病变2例。靶病变平均狭窄(85.6±15.0)%,靶血管参考直径(2.8±0.3)mm。对32支靶血管共置入36枚支架。支架平均长度(25.5±13.6)mm。PCI即刻成功率100%,无PCI相关严重并发症发生。随访期12～114个月[平均(60±35)个月],26例均存活,无迟发内漏或需二次手术者及不良心脏事件发生。结论覆膜支架联合PCI治疗Stanford B型主动脉夹层合并冠心病安全可行,手术成功率高,术后患者恢复快,冠脉PCI的抗凝治疗未对大动脉覆膜支架术后构成不良影响,近、远期疗效可靠。

Combined intervention treatment of thoracic aortic dissection with coronary heart disease

Objective To evaluate the effectiveness and safety of combination technique in treating Stanford B type thoracic aortic dissection with coronary heart disease by endovascular graft exclusion(EVGE) and percutaneous coronary intervention(PCI).Methods From April,2002 to October,2010,a total of 26 in-hospital patients with Stanford B type aortic dissection and coronary heart disease who underwent EVGE and PCI were analyzed for outcomes.All patients were performed EVGE before they were underwent PCI in 3~7 days’ s time.Short-term and long-term treatment were observed.Results Dissection tears,which were confirmed by aortic angiography during intervention trans-radial approach,originated within 0~10 mm from exterior margin of left subclavian artery in 8 patients,11~30 mm in 11 patients and 31~100 mm in 6 patients.One patient had two tear gaps,which originated within 15 mm and 100 mm from exterior margin of left subclavian artery.26 trunk tectorial membrane stents were used with lengths ranged from 60 to 157 mm and diameters ranged from 32 to 40 mm.In 8 patients,left subclavian artery was partially or thoroughly covered by the proximal section of the graft,which resulted in a weak left radial artery pulse but without any obvious ischemic symptom of the left upper limb and brain.The rate of success of EVGE implantation was 100%.Post-procedure aortography showed proximal gaps were thoroughly covered in 16 patients and minor leakage in 13 patients.Coronary artery angiography showed that there were 16 single-vessel disease,8 double-vessel disease and 2 triple-vessel disease.The mean narrowing rate of PCI target lesions was(85.6±14.0)%.The mean diameter of PCI reference vessels was(2.8±0.3)mm.36 stents were placed to 32 target vessels of 26 patients.The mean length of stents was(23.5±13.6)mm.The rate of success of PCI procedure was 100% and no severe complication occurred.A mean follow-up of(60±35)months ranged from 12 to 114 months reveals that all patients are alive by now.Neither delayed endo-leak and adverse cardiac events nor repeat intervention was found during follow-up period.Conclusion It is safe and feasible that treating Stanford B type aortic dissection with coronary heart disease by combination technique of EVGE and PCI.It was taken high procedure success rate and quick recovery for patients.The anticoagulant therapy of PCI not interfered with EVGE.The short-term and long-term outcome were very well,but further study is needed to investigate its longer outcome.